The ACEP Research Forum, held at our annual scientific meeting, focuses on cutting edge research. In 2017, the forum included outstanding expert state-of-the-art talks on how research is incorporated into clinical practice guidelines and how landmark articles come into being. There was also a session including legislators and researchers discussing the opioid crisis. This article highlights just a few of the research abstracts that may help your practice.
You can find all the abstracts presented at the ACEP17 Research Forum in Annals of Emergency Medicine’s October 2017 supplement.
Multicenter Trial of Rivaroxaban for Early Discharge of Pulmonary Embolism From the Emergency Department (MERCURY-PE)
Peacock W, Diercks D, Francis S, et al
This multicenter, prospective, open label, randomized clinical trial sought to determine what happens to low risk pulmonary embolism (PE) patients who are discharged home straight from the emergency department with rivaroxaban compared to standard care (SC; observation unit stay or inpatient admission). Not surprisingly, mean total hospital days (for any reason) at 90 days after randomization were significantly less for rivaroxaban than SC; 0.8 versus 1.8 days. The composite safety endpoint was similar in both groups. This industry-funded study suggests that carefully selected patients with PE can be managed as outpatients from the emergency department.
Trends in Site of Care for Low-Acuity Conditions Among Those with Commercial Insurance, 2008–2015
Poon SJ, Schuur JD, Mehrotra A
This study examined an insurance database for visits related to three low-acuity complaints. They found not only that emergency departments were seeing a decreasing proportion of these types of visits, but also that this decrease was due to an increase in “new” visits to urgent care and retail clinics (additive visits, not substitution). Thus, these clinics did not “steal” visits from the emergency department, but “created” visits through supply-induced demand.
Association of State Gun Laws with Pediatric Mortality from Firearms
Patel SJ, Badolato G, Parikh K, et al
In this politically timely abstract, the authors analyzed Centers for Disease Control and Prevention (CDC) data for firearm-related mortality in children 0–21 years of age and measured whether there was a relationship to state-specific Brady Campaign Gun Law Scores for 2015. The CDC noted that 4,528 children died from firearm-related injuries in 2015. Higher pediatric mortality rates were associated with lower (less strict) state-specific gun law scores. More specifically, median mortality rates were lower among the 12 states requiring universal background checks for firearm purchase (3.8 versus 5.7 per 100,000 children) and ammunition (2.3 versus 5.6 per 100,000 children). Although observational, these data provide the best available evidence to guide policy development.
Effect of SEP-1 Core Measure Compliance on Mortality and Hospital Length of Stay
E.A. Gross, G. McGlynn
Fluid Resuscitation of Septic Patients at Risk for Fluid Overload
M. Akhter, M. Hallare, A. Roontiva, et al